From Simple Medical History to Complex Diagnosis—A Rare Case of Sertraline-induced PPHN

Background: Persistent pulmonary hypertension of the newborn (PPHN) is a rare, heterogeneous disease with high mortality and morbidity among survivors. Etiologically, a distinction is made between idiopathic PPHN due to intrauterine-acquired abnormal vascular remodeling and PPHN in the context of impaired pulmonary vasodilation. Parenchymal disorders characterize the secondary PPHN due to meconium aspiration or pneumonia. Other rare causes may be abnormal lung development, interstitial lung diseases, pulmonary venous hypertension, intravascular obstruction, or neurological diseases. We present a neonate showing postnatally increased respiratory failure due to severe PPHN with an unusual cause.

Methods: Description of a single case of a preterm neonate who presented with prolonged PPHN due to sertraline exposure during pregnancy.

Results: This 36^5/7 weeks neonate developed increasing respiratory distress within 3 hours after birth. The anamnesis revealed therapy of the mother with sertraline during pregnancy for severe depression. The child required stabilization with invasive ventilation and inhaled nitric oxide, as well as catecholamine support. Echocardiography showed PPHN with a significantly dilated hypertrophied right ventricle (RV) and signs of suprasystemic RV pressure. Recurrent pulmonary hypertensive crises required additional drug therapy with prostaglandin E1, endothelin receptor antagonists, PDE-5 inhibitors, and intravenous prostacyclin. A CT scan of the lungs showed nonspecific diffuse ground-glass opacities. Genetic tests revealed no pathological findings. A diagnostic cardiac catheterization ruled out pulmonary vein stenosis and significant postcapillary pathology. Due to severe pulmonary hypertension, a PDA stent was placed to relieve the RV load and improve cardiac output. A lung biopsy showed diffuse pulmonary interstitial glycogenosis and medial hypertrophy of the pulmonary arteries. In the further course, the PPHN regressed with a reduction in RV pressure, allowing us to wean from intravenous prostacyclin. Home oxygen supplementation is still required 6 months after the initial discharge.

Conclusion: After excluding all other known etiologies, sertraline-induced PPHN is the most likely cause in this severe case of PPHN. Targeted combination therapy and PDA stenting were critical to the patient’s management. This unusual case highlights the importance of comprehensive diagnostics and combined therapeutic strategies to optimize the outcome of PPHN in neonates.

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Artikel online veröffentlicht:
11. Februar 2025